Provider Demographics
NPI:1093540650
Name:DUSABLON, JESSICA (RN)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:DUSABLON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:796 DEL VISTA CT
Mailing Address - Street 2:
Mailing Address - City:VILLA RIDGE
Mailing Address - State:MO
Mailing Address - Zip Code:63089-1806
Mailing Address - Country:US
Mailing Address - Phone:314-971-8192
Mailing Address - Fax:
Practice Address - Street 1:321 KNAUST RD
Practice Address - Street 2:
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-1715
Practice Address - Country:US
Practice Address - Phone:636-441-6465
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-04
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020027300163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse